~ A Journal of Democracy and Public Affairs

Opioid puzzlement: simple solutions, hard to execute

FBI proudly serves the public welfare to reduce over-prescription of painkillers with its Criminal Division’s Appalachian Regional Prescription Opioid Strike Force (ARPO). Wonderful. The more arrests you make, the fewer people will die, right? First you want to ask, why does the FBI police prescription drugs, which are by definition legal? Do Medicare and Medicaid even have effective internal controls in place?

Let’s take the simplest business model. If doctors, pharmacists, insurance companies, and pharmaceutical companies all make money from patients who overdose on painkillers, would that not signal the medical profession’s integrity and reputation are at stake? Moreover, internal controls would not be hard to put in place. If you have the FBI doing ‘takedowns’ at clinics and pharmacies that have never violated a written statute, that means the FBI has decided the business model must be stopped, independent of the law.

By conservative estimates, about a thousand persons a week die from taking drugs that are legal.

The so-called opioid crisis has been going on a long time. I say ‘so-called’ because crises are supposed to be shorter than, say, a decade. By conservative estimates, about a thousand persons a week die from taking drugs that are legal. That number has held pretty steady over the last several years. A thousand a week means a quarter million people have died from taking prescription drugs since ACA started to make these drugs affordable. No, I’m not going to lay this one at ACA’s door, as I have no evidence, but I’m surprised no one has asked about it. I appreciate the frankness of the federal drug enforcement agent who commented, “I would classify it as federally funded drug dealing.”

All of the coercive, state-run efforts to reduce opioid use have one thing in common: they don’t work.

If he’s right, why have federal efforts to deal with drug overdoses been so ineffectual? Does law enforcement need a different model? Here in Massachusetts, state authorities have proposed, enacted, implemented, and evaluated all sorts of coercive programs to make people stop taking painkillers that put their lives at risk. None of it works. If it did work, New Englanders would not continually worry over the opioid crisis, or worry over it right now. Periodically the Boston Globe does a front-page article about the latest effort, or the latest failure. All of the coercive, state-run efforts to reduce opioid use have one thing in common: they don’t work. Yet the Globe never runs an article about a new model, a departure that might achieve the goal.

By now you want to ask, “Alright, what’s your solution?” I’m not going to give one, as I do not know markets for potent painkillers well. I know a little about them, but not enough to prescribe solutions. I’ll say this: any solution that relies on state enforcement of dubious laws will not work in the long run. You know in advance, for example, that ARPO will receive praise every time it conducts a ‘takedown’, but the number of deaths per day or per week will not decline. Legal measures will not reduce the demand for painkillers, and suppliers will find a way to meet demand.